温氧合血停搏液诱导停搏及复苏再灌注对心肌保护作用的实验研究

EXPERIMENTAL STUDY ON MYOCARDIAL PROTECTION WITH WARM OXYGENTED BLOOD CARDIOPLEGIA INDUCING CARDIAC ARREST AND RESUSCITATIVE REPERFUSION

本文研究 3种不同灌注方法对心肌的保护作用。犬 2 1只 ,随机分为 3组 (每组 7只 )。A组及B组分别用冷晶体、冷氧合血停搏液间灌 ,C组在B组基础上用温氧合血停搏液诱导停搏及复苏再灌注 ,体外循环下心肌缺血 90min再灌注 3 0min期间 ,观察心脏电机械活动、转流前后左心功能、心肌肌酸磷酸肌酶释放量及摄氧量、心肌含水量及超微结构变化。结果显示 :B、C组复苏后血液动力学的稳定性、左心功能恢复优于A组 ,肌酸磷酸肌酶释放量、心肌含水量及超微结构损害程度明显低于A组。C组心肌停搏及复苏极少出现室颤 ,自动复跳率高 ,心肌摄氧量高于B组 ;再灌注 3 0min时 ,心肌肌酸磷酸肌酶释放量明显低于B组 ,心肌水肿及超微结构损伤较B组略轻。表明冷氧合血停搏液间灌法具有明显减轻心肌缺血性和再灌注损伤作用 。

mongrel dogs were equally devided into three groups at random. Group A and B received intermittent cold crystal cardioplegia and cold oxygented blood cardioplegia respectively. Group C received warm oxygented blood cardioplegia inducing cardiac arrest and resuscitative reperfusion on the base of Group B. Cardiac electric-mechanical movement, left ventricle function, myocardial CPK elease, water contents, oxygen extraction and ultrastructrue were measured during 90 minutes of global ischemia and 30 minutes of reperfusion under cardiopulmonary bypass. As a result, the stabilily of hemodynamics, left ventricle function recovery, CPK release, water contents and ultrastructure changes after reperfusion were better in Group B and C than that in Group A. Ventricular fibrillation did not happen almost during cardiac arrest and resuscitative reperfusion in Group C. Spontaneous resumed heart beat rato and myocardial oxygen extration were high in Group C than in Group B. After 30 minutes of reperfusion, myocardial CPK release, Water contents and ultrastructure changs were better in Group C than that in Group B. It is suggested that intermittent cold oxygented blood cardioplegia can abate myocardial ischemia and reperfusion damage obviously, while warm oxygented blood cardioplegia inducing cardiac arrest and resuscitative reperfusion has better myocardial protective effect.